The conundrum of iron in multiple sclerosis – time for an individualised approach, Metab Brain Dis (2012)

Abstract Although the involvement of immune mecha- nisms in multiple sclerosis (MS) is undisputed, some argue that there is insufficient evidence to support the hypothesis that MS is an autoimmune disease, and that the difference between immune- and autoimmune disease mechanisms has yet to be clearly delineated. Uncertainties surrounding MS disease pathogenesis and the modest efficacy of currently used disease modifying treatments (DMTs) in the prevention of disability, warrant the need to explore other possibilities. It is evident from the literature that people diagnosed with MS differ widely in symptoms and clinical outcome - some patients have a benign disease course over many years without requiring any DMTs. Attempting to include all patients into a single entity is an oversimplification and may obscure important observations with therapeutic con- sequences. In this review we advocate an individualised approach named Pathology Supported Genetic Testing (PSGT), in which genetic tests are combined with biochem- ical measurements in order to identify subgroups of patients requiring different treatments. Iron dysregulation in MS is used as an example of how this approach may benefit patients. The theory that iron deposition in the brain con- tributes to MS pathogenesis has caused uncertainty among patients as to whether they should avoid iron. However, the fact that a subgroup of people diagnosed with MS show clinical improvement when they are on iron supplementation emphasises the importance of individualised therapy, based on genetic and biochemical determinations.
“..Conclusion
The conundrum of iron in MS may be solved when it is approached from an individualised point of view. The heterogeneity of the disease warrants the following question: What factors are present that may impact on demyelination and how should they be alleviated in individual patients? Adequate research already exists on essential requirements for oligodendrocyte survival and remyelination. The value of biochemical testing performed in conjunction with a medical, lifestyle and genetic assessment when appropriate (Pathology Supported Genetic Testing), should not be under-estimated. Further studies are essential to establish the validity of these concepts...”

full paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402663/